Archive for June 2013

Recently, I blogged a piece about how small enterprises are helping to prepare the way in which local care services are delivered into Dudley’s community.

I zoned in on Sarah Goudie’s bread2share project for people living with learning disabilities as it made national headlines in The Guardian.

Set up 18 months ago, the micro provider project based at the Queens Cross Network on Wellington Road, helps clients make bread. I just love the creativity of this kind of caring.

All micro projects are community focused and Dudley Council provides financial and business support as part of its goal to develop more personalised, community-bases social care.

The Dudley Innovation Fund awards “kickstart” funding grants of £2,000 and “progression” funds of up to £10,000, The Guardian article said.

Matt Bowsher, assistant director of Quality and Commissioning in Dudley, emailed me and asked me to clear up a couple of details in the blog.

I wrote: “I find the initiative heartening and it’s certainly a creative way of saving cash. However, the savings, according to the article, are estimated at only 10 per cent.”

He pointed out: “The 10 per cent figure quoted in the (Guardian) article refers to the maximum proportion of care services that are delivered by micro enterprises as opposed to a savings target.”

He also added there was nothing in the national newspaper article “that references micro enterprises as a means to deliver care on the cheap or achieve savings.”

On my question regarding CQC registrations, Mr Bowsher added: “In terms of registering with CQC, there is no need for micro providers to do so unless they deliver personal care, in which case the Care Standards Act applies as it would to any provider.

“Micros in Dudley play a valuable role and usually provide support that is fairly unique in nature and the last thing I would want to communicate to micros is that we see them as a means to deliver cheap care; it isn’t the case.”

The Daily Mail claims that it “revealed” a problem of bed locking by elderly people is at a record level “because of a critical shortage of home helps and nursing home places.”

Tell me something new, please. I was not aware the publication had sole revelation rights on this matter, as it’s common knowledge in the care sector.

But I do note with interest the article this week telling us that “more than £2billion of Health Service cash” will be raided to give councils a chance of ending the problem.

Ask any care worker who has acted as an escort taking older people to hospital and they will readily tell you how easily their ‘charges’ can become trapped in hospitals.

The idea of the extra funding is so that hospital discharge units will be able to place such people in to residential or nursing care, or better still, their own homes once they are declared fit.

Chancellor George Osborne said he wanted to end the ‘scandal’ of frail elderly people being ‘dropped at A&E on a Friday night’ by a failing social care system, the Daily Mail reported

According to the publication, the number of bed days lost to the NHS is now the highest since the election, with pensioners who should be discharged stuck on wards for an average of 30 days because they are too frail to be sent home on their own.

In his spending review speech, the Chancellor admitted that far too often elderly people ‘fall between the cracks’ of health and social care.

That’s so true and I’m heartened that George Osborne is aware of the problem.

The Mail reported that he spoke of the elderly “being pushed from pillar to post and not getting the care they should’” . . .

“None of us here would want that for our parents or grandparents, and in a compassionate society no one should endure it.”

He hoped that shared NHS budgets would offer a join-up approach to care, and so do I.

There’s a new buzzword being banded about in the NHS and social care – integration.

It’s the pioneering programme devised by health minister Norman Lamb. Already columnists and health worker have hit the public forums with the integration solution being couched in comic book hero terms.

But we do need a solution. After all, integration of streams of care on paper seems a good idea.

I’m not an expert, but some aspects are innovative. Not least is the prospect of new payment flexibilities – a shift away from paying hospitals for discrete activities towards rewarding them for developing integrated care pathways back into the community.

My abiding concern in the ‘real world’ of caring is that there are huge divides still between social care and the NHS – not an easy fix; inadequate funding – CCGs are being asked to give two per cent of their budgeting to this cause and already cash is tight; there’s the political issue of who gets priority; and frankly, I don’t believe the initiative will fix the billions of pounds shortfall politicians are speaking of.

I do, however, praise the bravery of this plan. No doubt those selling tickets for events which explore the reality of integration are doing a roaring trade.

One thing that I would hope emerges is that our members are, indeed, seen as part of a solution.

The National Care Home Open Day last Friday has opened some interesting debates – not least, the fact that residential homes could become community hubs for care.

Martin Green, head of the English Community Care Association, proposes that homes could offer advice, information, training and other services to local carers, run “reablement” or convalescence courses for people discharged from hospital, or host clinics for NHS treatment, not just for residents but also for people living in the vicinity.

And in his national press article, he goes further suggesting surgeons could even carry out minor operations in care homes, saving the NHS the cost of inpatient stays.

There’s no denying Martin is a visionary. He cites the award winning Billericay home in Essex as a benchmark for community involvement. Operated by the Hallmark group, it has a community room used for outside groups and classes.

Central to the community deal is that residents must be able to join in if they wish to.

“The home already looks and feels like part of the neighbourhood,” he writes in The Guardian.

What a great idea to have more community involvement in our homes. The potential is endless: Schools, colleges, universities, training programmes, volunteers . . . but, and as ever it’s a huge ‘but”.

With such radical, creative ideas, there always comes a cost. But not to be left dead in the water on this issue, Martin has this to say: “We need a radical reapportionment of budgets across health and social care, bringing together the NHS’s £121bn and social care’s £8bn. People could then commission outcomes, not services. The real problem is that the health service seems incapable of understanding anything other than commissioning a health service.”

Will this be the shape of care to come? I really don’t know if there’s the political will to make it happen, What I do know, however, is that thousands joined the National Care Home Open Day event to engage with community – some for the very first time.

Care is continually changing and many of the changes are driven by regulations we have no control over. It’s time we took the initiative and help change things we can and not least the public perception of residential care.

Craft workshops, cookery, everything from dance to fancy dress bingo will be on show today at the National Care Home Open Day.

It’s the first time there has been a national initiative to showcase the work of residential care.

And amongst the events, Lord Michael Bichard, chair of the Social Care Institute for Excellence, is due in Edgbaston, Birmingham, to visit a Barchester scheme which sees young people with special educational needs going into their local care home.

This pioneering work thrills me. Some take part in arts projects and others are doing work experience, such as typing and catering.

We estimate some 2,000 homes are taking part in the day, but Lord Bichard, writing in The Guardian yesterday, makes a valid point: We need to see care homes opening their doors more frequently than once a year, he says.

Indeed, many do. But so many more need to embrace the concept of community involvement.

The celebrated peer enthuses that such a course of action:

Means residents are not just forgotten people who live down the end of a driveway

It’s likely to mean that residents are more involved in what’s happening locally

It helps ensure that residents receive a more personalised and rich experience, and remain motivated and engaged with their community

He also argues that “there are other reasons why it’s important that care homes are seen to be more transparent.”

Many homes, of course, provide excellent care, he adds, but we must all be concerned about the scenes we have recently seen from homes where standards have dropped to an unacceptable level.

“Often, relatives can be reluctant to complain about anything, for fear of being labelled ‘troublemakers’. Equally, inspectors can only ever provide a snapshot of care quality. How true!

“So it’s really very important to have a steady flow of local people coming through the doors, to provide not just opportunities for the residents, but a regular, extra quality check,” he says.

There are so many plus factors in the National Care Home Open Day event. I’m fully supportive of the peer when he comments: “Let’s hope that the open day ushers in a new way of thinking so that care homes are open more generally and that an open day is a thing of the past.”

Care homes across the UK will be going public tomorrow in the fist National Care Homes Day.

They will be inviting people to look and see what they can do, the care they give and how it’s delivered.

There will be tea and cakes, perhaps some dancing and site tours as staff and residents engage with the community.

It’s all about showing how the role of residential and nursing homes has changed dramatically in recent years.

Sadly, care in residential settings is desperately misunderstood. Dependency levels these days are far greater.

As Martin Green, head of the English Community Care Association, said in the Guardian: “People in care homes today would have been in geriatric hospitals 15 years ago, which is why they don’t get out as much and why homes may seem to have become cut off, and on the side of society. What’s more, the funding mechanism hasn’t caught up with the change.”

How true that all is.

English councils last year paid an average £480 a week for state-funded residential home placements – between £50 and £140 less than what it calculated was a “fair market price”.

The knock-on effect is that self-funding care home residents are effectively cross-subsidising those on council rates as homes struggle to balance the books.

I believe care operators are rightly rewarded for the high risks they take. It is like no other business sector, with masses of regulation, inspections galore and all against a blame-centric society looking for easy payouts.

Despite the challenges, anyone can go and see first-hand what care is about as homes embrace the Care Day initiative.

The hope is that many of the 2,000-plus care homes opening their doors on Friday will be part of a national re-education programme in the industry to show just how excellent the majority of care-giving is and hopefully give some insight into its true worth.

Just when I think I’m getting a respite from the issues in the great funding debate the BBC go and spoil it – well, not really.

Wading into the Beeb’s headlines yesterday was Chris Ham from the King’s Fund, who said there should be a pooled resource for health and social care budgets as an ageing population meant more people had needs that spanned the two services.

The current system established after the Second World War has two distinct streams of care: Social care which is means tested and NHS care which is free at the point of use. It also has two funding streams.

We have head too many times that increased pressure on local authorities to make even more savings, couple with the prospect that central government will also cut their allocations, will eventually hit at our most vulnerable.

In 2016 we will see the cost of social care capped at £72,000 in an attempt to bring some limit to the public obligation to care, but I do not believe is will solve any of the fundamental problems of delivering sustainable, good quality care and financing it.

Now the King’s Fund is calling for a fundamental review to look at what was set in motion with the NHS in 1948 and how this great institution can work hand-in-glove alongside social care in the future.

Successive governments have failed to get this debate airborne but now says Lamb “the planets are aligned” for change.

To this end the Fund wants a radical single budget. But according to Minister Norman Lamb this is already being made to happen locally.

Where? I ask. What local authority is getting NHS ‘ring fenced’ cash to boulster social care?

Clearly closer integration is needed between NHS and social care as we address the demographic changes, but as ever, the devil will be in the detail.

Lamb said on the BBC interview said there should be a “fully-integrated system by 2018” and the government is to make announcements in September that would “really push the boundaries”.

We don’t know what’s coming next, but I bet it’s not going to be an easy pill to swallow.